Experience of laparoscopic incisional and ventral hernia repair (2005 – 2012) UO di Chirurgia Dott. Paolo A. Riccio.

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Presentation transcript:

Experience of laparoscopic incisional and ventral hernia repair (2005 – 2012) UO di Chirurgia Dott. Paolo A. Riccio

Patient Characteristics (222) Male/Female84/138 Age (y)61.7 (15-88) Body mass index28.8 (18-45) ASA classification2.1 (1-3) Previous open hernia repair 24 (10.8%) Max diameter size (cm)8.4 (2-28) Operating time (min)97.5 (25-240) Postoperative hospital stay (d) 4.8 (1-27) Associated procedures cholecistectomy 5 inguinal hernia

Type of defect (1) Laparoscopic Incisional Hernia Repair - LIHR (172) Median laparotomies 145 Lateral: 24 Left side 5 Mc Burney 5 Subcostal 10 Lumbar hernia 4 Parastomal 3 Laparoscopic Ventral Hernia Repair - LVHR (50) Umbilical hernia 29 Epigastric hernia 21

Type of defect (3) Chevrel classification Small (<= 5 cm)45 (20.2%) Medium (6-9 cm)69 (31.0%) Large (=> 10 cm)71 (32.1%) Type of defect (2) ABDOMINAL BORDER (42) Subxiphoidal 8 Suprapubic 24 Subcostal 10 Type of defect (4) Swess-Cheese37 (16.7%)

Type of Prosthesis SEPRAMESH VENTRALIGHT 40 (18.0%) 20 (9.0%) DYNA-MESH12 (5.4%) PARIETEX 5 (2.2%) COMPOSIX 33 (14.8%) PROCEED 110 (49.5%) PHISIOMESH2 (0.9%)

Type of fixation (1) ABSORBABLE TACK 52 (23.5%) NON ABSORBABLE TACK170 (76.5%)

Type of fixation (2) Use of Tissucol

OUTCOMES Complications 32 (14.4%) Recurrence 12 (5.4%) Conversion to open technique 8 (3.6%)

COMPLICATIONS (32) Prolonged seroma (> 8 wk)12 (5.6%) Prolonged ileus10 (4.7%) Prolonged pain (> 6 months)5 (2.3%) Pulmunary Embolism1 (0.6%) Myocardial Infarction1 (0.6%) Pneumonia + wound infection1 (0.6%) Wound infection2 (0.9%) RE-OPERATION (7) Intestinal injury4 (1.8%) Postoperative bleeding2 (0.9%) Trocar site erniation1 (0.6%)

RECURRENCE 12 (5.4%) Time to recurrence (days): 537 ( ) Treatment of recurrence: Laparoscopic repair 2 Open repair 5 No repair 5

CONVERSION TO OPEN TECHNIQUE 8 (3.6%) Severity of adhesions 5 (2.2%) Severity of adhesions and obesity 1 (0.5%) Complete prosthesis detachment 1 (0.5%) Intestinal injury 1 (0.5%)